While standardised hospital rates can enable predictability in healthcare costs, broader use of the National Health Claims Exchange can reduce the time taken for admission and discharge of patients. In an interview with Narayanan V, Aditya Birla Health Insurance Company CEO Mayank Bathwal speaks about how the National Health Claims Exchange can bring about transparency in timelines and costs, benefitting patients, insurers as well as hospitals. Excerpts:
Why is it crucial to standardise hospital rates and ensure hospitals follow the General Insurance Council guidelines?
About 70% of the cost to insurers is actually healthcare cost. Health insurers are not telling hospitals to bring down the cost. They are telling them to create predictability. They should create efficiency in cost by following standard treatment protocols decided by medical experts such as the Indian Council of Medical Research. The second is common empanelment —hospitals can be categorised based on their cost structure and then have similar rates for all insurers. Third, all stakeholders should use the National Health Claims Exchange (NHCX). It will reduce the time taken for admission, discharge, etc. Plus, it will create transparency.
How can the National Health Claims Exchange bring greater efficiency to claims settlement?
Globally, information between hospitals and insurers is exchanged through exchanges or what are called pipelines. Today, every insurer has its own portal. Under the NHCX, one integration layer will ensure the data flows seamlessly between hospitals and insurers. When data starts flowing in, you start getting a sense of what the care cost is behind them. It will create transparency in timelines, costs, etc., and transparency is the best way to create efficiency. This way complaints relating to delays can be solved.
How can Bima Sugam help prevent mis-selling, particularly during portability?
One of the challenges of the industry is the distribution cost. Bima Sugam is the best way to solve that because it is a common layer owned by all the insurance companies. You are not having to go through any intermediary. Therefore, the best products at the right price will be available. It is going to reduce the cost of distribution and also create more transparency. The segment of customers who are worried about whether they are buying from the right place or the right product will have a lot more reassurance when they buy from Bima Sugam.
Why are preventive care and outpatient department (OPD) cover becoming increasingly important in health insurance?
OPD is a good way to bring in more health data and, therefore, more awareness. You can intervene early if you realise that diabetes or blood pressure is recurring. We can then reward or nudge consumers and create pathways for them. We have now started doing personal, hyper-personalised engagement with consumers around their health. Our claim ratio for that cohort of consumers who earn some health benefit is lower by 6-7%, and persistency is higher by 12-13%. That’s the cohort of consumers you definitely want to retain. Otherwise, that good-health cohort would have left insurance thinking they didn’t get anything.
How does Aditya Birla Health Insurance approach preventive care and health awareness?
Our products reward consumers with even 100% premium refund if they take good care of their health. They can use that to pay their renewal premium.About 9,200 customers got 100% of their premium back. About 12% of our consumers earn some benefit for good health behaviour, while 5-6% earn some sickness benefit. Our whole proposition is built around this theme: know your health, improve your health, get rewarded. If something happens, stay protected.